REAL-TIME HEALTH OUTCOMES AMONG OLDER ADULTS INITIATING MEDICAL CANNABIS FOR CHRONIC PAIN

Abstract Background: Rigorous data are needed on the short- and long-term effects of medical cannabis (MC) on older adults with chronic pain. In response, this prospective study combines technology-based ecological momentary assessments (EMA) and in-person visits over 12 months to obtain subjective and objective data on MC’s effects on older adults. Method: The study recruits and follows older adults (50 years or older, 50% male) with chronic pain for one year. Some will have initiated MC (MC group) and others will not use MC (comparison group). Target enrollment will be 328 (1:1 ratio for MC and comparison group) participants. Collection of subjective and objective data occurs at in-person visits (baseline & 12 months) and via smartphone- and sensor-based measurement bursts at 1, 3, 6, and 9 months. The EMA data capture detailed MC use patterns and subjective short-term outcomes (e.g., pain intensity rating). These data will be integrated with objective data collected using a wearable sensor-based Fitbit (e.g., physical activity and sleep). Results: Multilevel modeling will examine changes in real-time symptoms measured by EMA and objective, sensor-based behavioral outcomes. Results will include changes in momentary pain intensity rated on 0-100 visual analog, real-time anxiety and depressive symptoms, daily sleep duration and quality, and level of physical activity. Conclusions: Our results will provide evidence on whether older adults who initiate MC will have greater reductions in real-time pain intensity and more improvements in physical and emotional functioning compared to those in the comparison group.


THE ASSOCIATION BETWEEN MEDICAL MARIJUANA USE AND DIVIDED ATTENTION ON A SIMULATED DRIVING PERFORMANCE TASK
Nicole Ennis 1 , Daniel Dunleavy 2 , Katie Kloss 2 , Nichole Stetten 3 , and Sherrilene Classen 3 , 1.Florida State University, Tallahassee, Florida, United States, 2. Florida State University-College of Medicine, Tallahassee, Florida, United States, 3. University of Florida, Gainesville, Florida, United States Driving is a complex and dynamic task requiring divided attention (DA), awareness of the traffic and surroundings while focusing on critical stimulus.The goal of this project was to examine the relationship between medical marijuana use and divided attention in adults 50 and older during a simulated driving performance task.We recruited adults 50 and older (N=20) pre-exposure to medical marijuana and followed them for the first 3 months of use.Driving performance was examined at baseline (pre-exposure to medical marijuana) and 1-month post medical marijuana exposure During a driving performance identification task that appeared in central or peripheral vision during the simulated drive, DA was assessed as a triangle that appeared on screen at pre-programmed intervals to which participants were required to press a button on the dashboard in response.Results showed that at 1-month post-medical marijuana initiation the 7-day pattern of use could be classified as light, moderate, or heavy.Further, there was a trend of improved performance among medical marijuana users 50 and older with moderate to heavy use having the best performance on the DA.We attribute these findings to the stimulant properties of medical marijuana and improved sleep reported by participants.

REAL-TIME HEALTH OUTCOMES AMONG OLDER ADULTS INITIATING MEDICAL CANNABIS FOR CHRONIC PAIN
Yan Wang 1 , Kimberly Sibille 1 , Zhigang Li 1 , Rene Przkora 1 , Seigfried Schmidt 1 , Margaret Lo 1 , Ana Abrantes 2 , and Robert Cook 1 , 1. University of Florida,Gainesville,Florida,United States,2. Brown University,Providence,Rhode Island,United States Background: Rigorous data are needed on the short-and long-term effects of medical cannabis (MC) on older adults with chronic pain.In response, this prospective study combines technology-based ecological momentary assessments (EMA) and in-person visits over 12 months to obtain subjective and objective data on MC's effects on older adults.
Method: The study recruits and follows older adults (50 years or older, 50% male) with chronic pain for one year.Some will have initiated MC (MC group) and others will not use MC (comparison group).Target enrollment will be 328 (1:1 ratio for MC and comparison group) participants.Collection of subjective and objective data occurs at in-person visits (baseline & 12 months) and via smartphone-and sensor-based measurement bursts at 1, 3, 6, and 9 months.The EMA data capture detailed MC use patterns and subjective shortterm outcomes (e.g., pain intensity rating).These data will be integrated with objective data collected using a wearable sensor-based Fitbit (e.g., physical activity and sleep).Results: Multilevel modeling will examine changes in real-time symptoms measured by EMA and objective, sensor-based behavioral outcomes.Results will include changes in momentary pain intensity rated on 0-100 visual analog, real-time anxiety and depressive symptoms, daily sleep duration and quality, and level of physical activity.Conclusions: Our results will provide evidence on whether older adults who initiate MC will have greater reductions in real-time pain intensity and more improvements in physical and emotional functioning compared to those in the comparison group.

CANNABIS USE IN OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY Divya Bhagianadh, Rutgers University, Newark, New Jersey, United States
Cannabis use among persons over 50 years old has tripled since 2000.Some studies have found negative outcomes associated with increasing use of cannabis use among older adults such as higher rates of injury and emergency department use.Other studies have shown improvements in pain, sleep and other outcomes such as self-reported health and labor force participation.In this study, we identify individual determinants and outcomes related to cannabis use among adults aged 50+ sourcing data from the 2018 cannabis module of the Health Retirement Survey and constructing a longitudinal panel by linking this data with the respondents' 2016 and 2020 data.Among the 1,372 respondents, 10% reported past year use.Among these past year users, 35% were persistent, lifelong users and nearly 25% used solely for medical purposes.Multivariate logistic regression controlling for demographics, health and functional status and individual fixed effects showed that those who reported pain in the last wave had higher odds of reporting cannabis use (OR 1.70, p-value-0.03).Troubled sleep was associated with higher odds of cannabis use (significant at 10%).We did not see any effect of cannabis use on pain in later years or subsequent healthcare utilization (hospital or doctor visits).Our results reflect a nationally representative survey of cannabis use among aging Americans and affirms how motives and outcomes of cannabis use are age sensitive.

STATE VARIATION IN CANNABIS REGULATIONS CONCERNING OLDER AMERICANS Fadi Martinos, University of Iowa, Iowa City, Iowa, United States
As of 2022, 21 states have fully legalized cannabis, 23 legalize for medical use only, and 6 states prohibit cannabis use entirely.While previous research has associated discrete aspects of state cannabis regulation with individual outcomes, little is known about the administrative rules most relevant to older persons.We previously have observed how the progressive approach to legalization across the United States, which includes flexible regulation on legal access, medical program eligibility and qualifying conditions, potency limits, care giver autonomy and others has corresponded with increased accessibility and use of cannabis among Americans over 65 years old.In this study, we source data on seven distinct state regulations pertaining to older persons and measured each on a scale reflecting permissiveness relevant to access and use.We used individual item measures to construct aggregated scores of state policies and charted changes within and among these seven state policies from 2016 to 2022.This research advances scientific understanding by capturing finite distinctions among state regulatory approaches most likely to impact older persons and offering reliable time-varying measures to be included in multi-level model formulations.

ADVANCE CARE PLANNING IN PRIMARY CARE: ENGAGING ACCOMPANIED OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Chair: Jennifer Wolff Co-Chair: Diane Echavarria Discussant: Laura Gitlin Alzheimer's Disease and Related Dementias (ADRD) are among the most profoundly disabling and costly of all health conditions, and persons living with dementia are at heightened risk for high utilization of burdensome and costly end-of-life care.Family caregivers are at the forefront of managing ADRD, however, they are not routinely engaged in primary care discussions about prognosis and the healthcare preferences of the people for whom they care.Advance care planning (ACP) is a longitudinal communication process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care.Early initiation of ACP, communication with the primary care team, and the inclusion of associated caregivers is imperative in ADRD care due to progressive and devastating effects on decision-making capacity connected with the disease.SHARE, a multicomponent communication intervention, engaged 273 patient-family caregiver dyads in a randomized-controlled trial collecting baseline and six-month survey data related to experiences in the primary care setting.145 patient-caregiver dyads assigned to the intervention received an offer for a facilitated advance care planning conversation.This symposium will highlight 6-month outcomes from caregiver-reported surveys.Attendees will gain a perspective on ACP considerations in a cognitively impaired population including ethical considerations and the factors influencing preparedness for medical decision making for involved family caregivers.Additional attention concerning the quality and content of ACP conversations with patient-caregiver dyads and the development of a fidelity tool for usage with audio-recorded ACP conversations will be presented.